Drug Treatment & Substance Abuse

This report presents, for the first time, information from the 2002 National Survey on Drug Use and Health (NSDUH). This survey, formerly called the National Household Survey on Drug Abuse (NHSDA), is a project of the Substance Abuse and Mental Health Services Administration (SAMHSA). This survey was initiated in 1971 and is the primary source of information on the use of illicit drugs, alcohol, and tobacco by the civilian, noninstitutionalized population of the United States aged 12 years old or older. The survey interviews approximately 67,500 persons each year.

Because of improvements to the survey in 2002, estimates from the 2002 NSDUH should not be compared with estimates from the 2001 and earlier NHSDAs to assess change over time in substance use. Therefore, the 2002 data constitute a new baseline for tracking trends in substance use and other measures. However, it is possible to develop trend estimates based on respondents' reports of past substance use in the 2002 NSDUH. The estimates are presented in terms of lifetime and first-time substance use.

Illicit Drug Use

In 2002, an estimated 19.5 million Americans, or 8.3 percent of the population aged 12 or older, were current illicit drug users. Current drug use means use of an illicit drug during the month prior to the survey interview.
Marijuana is the most commonly used illicit drug, with a rate of 6.2 percent. Of the 14.6 million past month marijuana users in 2002, about one third, or 4.8 million persons, used it on 20 or more days in the past month.
In 2002, an estimated 2.0 million persons (0.9 percent) were current cocaine users, 567,000 of whom used crack. Hallucinogens were used by 1.2 million persons, including 676,000 users of Ecstasy. There were an estimated 166,000 current heroin users.
An estimated 6.2 million persons, or 2.6 percent of the population aged 12 or older, were current users of psychotherapeutic drugs taken nonmedically. An estimated 4.4 million used pain relievers, 1.8 million used tranquilizers, 1.2 million used stimulants, and 0.4 million used sedatives.
In 2002, approximately 1.9 million persons aged 12 or older had used OxyContin nonmedically at least once in their lifetime.
Among youths aged 12 to 17, 11.6 percent were current illicit drug users. The rate of use was highest among young adults (18 to 25 years) at 20.2 percent. Among adults aged 26 or older, 5.8 percent reported current illicit drug use.
Among pregnant women aged 15 to 44 years, 3.3 percent reported using illicit drugs in the month prior to their interview. This rate was significantly lower than the rate among women aged 15 to 44 who were not pregnant (10.3 percent).
The rates of current illicit drug use were highest among American Indians/Alaska Natives (10.1 percent) and persons reporting two or more races (11.4 percent). Rates were 9.7 percent for blacks, 8.5 percent for whites, and 7.2 percent for Hispanics. Asians had the lowest rate at 3.5 percent.
Among youths aged 12 to 17, the rate of current illicit drug use among American Indians/Alaska Natives (20.9 percent) was significantly higher than the rate among all youths (11.6 percent), and the rate among Asian youths (4.8 percent) was significantly lower compared with the overall rate for all youths.
An estimated 17.4 percent of unemployed adults aged 18 or older were current illicit drug users in 2002 compared with 8.2 percent of those employed full time and 10.5 percent of those employed part time. However, most drug users were employed. Of the 16.6 million illicit drug users aged 18 or older in 2002, 12.4 million (74.6 percent) were employed either full or part time.
In 2002, an estimated 11.0 million persons reported driving under the influence of an illicit drug during the past year. This corresponds to 4.7 percent of the population aged 12 or older. The rate was 10 percent or greater for each age from 17 to 25, with 21 year olds reporting the highest rate of any age (18.0 percent). Among adults aged 26 or older, the rate was 3.0percent.

Alcohol Use

An estimated 120 million Americans aged 12 or older reported being current drinkers of alcohol in the 2002 survey (51.0 percent). About 54 million (22.9 percent) participated in binge drinking at least once in the 30 days prior to the survey, and 15.9 million (6.7 percent) were heavy drinkers.
The prevalence of current alcohol use increased with increasing age in 2002, from 2.0 percent at age 12 to 6.5 percent at age 13, 13.4 percent at age 14, 19.9 percent at age 15, 29.0 percent at age 16, and 36.2 percent at age 17. The rate reached a peak of 70.9 percent for persons 21 years old.
About 10.7 million persons aged 12 to 20 reported drinking alcohol in the month prior to the survey interview in 2002 (28.8 percent of this age group). Of these, nearly 7.2 million (19.3 percent) were binge drinkers and 2.3 million (6.2 percent) were heavy drinkers.
About 1 in 7 Americans aged 12 or older in 2002 (14.2 percent, or 33.5 million persons) drove nder the influence of alcohol at least once in the 12 months prior to the interview.

Tobacco Use

An estimated 71.5 million Americans (30.4 percent of the population aged 12 or older) reported current use (past month use) of a tobacco product in 2002. About 61.1 million (26.0 percent) smoked cigarettes, 12.8 million (5.4 percent) smoked cigars, 7.8 million (3.3 percent) used smokeless tobacco, and 1.8 million (0.8 percent) smoked tobacco in pipes.
A higher proportion of males than females aged 12 or older smoked cigarettes in 2002 (28.7 vs. 23.4 percent). However, among youths aged 12 to 17, girls were slightly more likely than boys to smoke (13.6 vs. 12.3 percent).
In 2002, 17.3 percent of pregnant women aged 15 to 44 smoked cigarettes in the past monthcompared with 31.1 percent of nonpregnant women of the same age group.

Trends in Lifetime Substance Use

The percentage of youths aged 12 to 17 who had ever used marijuana declined slightly from 2001 to 2002 (21.9 to 20.6 percent). Among young adults aged 18 to 25, the rate increased slightly from 53.0 percent in 2001 to 53.8 percent in 2002.
The percentage of youths aged 12 to 17 who had ever used cocaine increased slightly from 2001 to 2002 (2.3 to 2.7 percent). Among young adults aged 18 to 25, the rate increased slightly from 14.9 percent in 2001 to 15.4 percent in 2002.
Lifetime nonmedical pain reliever prevalence among youths aged 12 to 17 increased from 2001 (9.6 percent) to 2002 (11.2 percent), continuing an increasing trend from 1989 (1.2 percent). Among young adults aged 18 to 25, the rate increased from 19.4 percent in 2001 to 22.1 percent in 2002. The young adult rate had been 6.8 percent in 1992.
The rate of lifetime cigarette use among youths aged 12 to 17 declined from 37.3 percent in 2001 to 33.3 percent in 2002.
The rate of lifetime daily cigarette use among youths aged 12 to 17 declined from 10.6 percent in 2001 to 8.2 percent in 2002. There also was a small decline in lifetime prevalence mong young adults (37.7 to 37.1 percent) from 2001 to 2002.

Trends in Initiation of Substance Use (Incidence)

There were an estimated 2.6 million new marijuana users in 2001. This number is similar to the numbers of new users each year since 1995, but above the number in 1990 (1.6 million).
Pain reliever incidence increased from 1990, when there were 628,000 initiates, to 2000, when there were 2.7 million. In 2001, the number was 2.4 million, not significantly different from 2000.
The number of new daily cigarette smokers decreased from 2.1 million in 1998 to 1.4 million in 2001. Among youths under 18, the number of new daily smokers decreased from 1.1 million per year between 1997 and 2000 to 757,000 in 2001. This corresponds to a decrease from bout 3,000 to about 2,000 new youth smokers per day.

Youth Prevention-Related Measures

Among youths indicating that "smoking marijuana once a month" was a "great risk," only 1.9 percent indicated that they had used marijuana in the past month. However, among youths who indicated "moderate, slight, or no risk," the prevalence rate was almost 6 times larger (11.3 percent).
The percentages of youths reporting that it was fairly or very easy to obtain specific drugs were 55.0 percent for marijuana, 25.0 percent for cocaine, 19.4 percent for LSD, and 15.8 percent for heroin.
Most youths (89.1 percent) reported that their parents would strongly disapprove of their trying marijuana once or twice. Among these youths, only 5.5 percent had used marijuana in the past month. However, among youths who perceived that their parents would only somewhat disapprove or neither approve nor disapprove of their trying marijuana, 30.2 percent reported past month use of marijuana.

Substance Dependence or Abuse

An estimated 22.0 million Americans in 2002 were classified with substance dependence or abuse (9.4 percent of the total population aged 12 or older). Of these, 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 14.9 million were dependent on or abused alcohol but not illicit drugs.
Among persons aged 12 or older in 2002, the rate of substance dependence or abuse was highest among American Indians/Alaska Natives (14.1 percent). The next highest rate was among persons reporting two or more races (13.0 percent). Asians had the lowest rate of dependence or abuse (4.2 percent). The rate was similar among blacks and whites (9.5 and 9.3 percent, respectively). Among Hispanics, the rate was 10.4 percent.
In 2002, an estimated 19.7 percent of unemployed adults aged 18 or older were classified with dependence or abuse, while 10.6 percent of full-time employed adults and 10.5 percent of part-time employed adults were classified as such. However, most adults with substance dependence or abuse were employed either full or part time. Of the 19.8 million adults classified with dependence or abuse, 15.3 million (77.1 percent) were employed.

Treatment and Treatment Need for Substance Problems

An estimated 3.5 million people aged 12 or older (1.5 percent of the population) received some kind of treatment for a problem related to the use of alcohol or illicit drugs in the 12 months prior to being interviewed in 2002. Of these, 2.2 million received treatment for alcohol during their most recent treatment. An estimated 974,000 persons received treatment for marijuana, 796,000 persons for cocaine, 360,000 for pain relievers, and 277,000 for heroin. Most people receiving treatment received it at a "specialty" substance abuse facility (2.3 million).
In 2002, the estimated number of persons aged 12 or older needing treatment for an illicit drug problem was 7.7 million (3.3 percent of the total population). Of these persons, 1.4 million (18.2 percent) received treatment for drug abuse at a specialty substance abuse facility in the past 12 months. Of the 6.3 million people who needed drug treatment but did not receive treatment at a specialty facility in 2002, an estimated 362,000 (5.7 percent) reported that they felt they needed treatment for their drug problem. This included an estimated 88,000 (24.4 percent) who reported that they made an effort but were unable to get treatment and 274,000 (75.6 percent) who reported making no effort to get treatment.
In 2002, the estimated number of persons aged 12 or older needing treatment for an alcohol problem was 18.6 million (7.9 percent of the total population). Of these, 8.3 percent (1.5 million) received alcohol treatment at a specialty substance abuse facility in the past 12 months. Of the 17.1 million people who needed but did not receive alcohol treatment, an estimated 761,000 (4.5 percent) reported that they felt they needed treatment for their alcohol problem. Of the 761,000 persons, 266,000 (35 percent) reported that they made an effort but were unable to get treatment, and 495,000 (65 percent) reported making no effort to get treatment.
Among the 1.4 million persons who received specialty treatment for an illicit drug problem in the past year, 33.9 percent reported "own savings or earnings" as a source of payment for their most recent specialty treatment. An estimated 30.0 percent reported private health insurance, 26.1 percent reported Medicaid, and 23.3 percent reported public assistance other than Medicaid as a source of payment.
Among the 1.5 million persons who received specialty treatment for an alcohol problem in the past year, 46.3 percent reported "own savings or earnings" as a source of payment for their most recent specialty treatment. An estimated 31.7 percent reported using private health insurance, 21.5 percent reported public assistance other than Medicaid, and 21.4 percent reported Medicaid.

Serious Mental Illness among Adults

In 2002, there were an estimated 17.5 million adults aged 18 or older with serious mental illness (SMI). This represents 8.3 percent of all adults. Rates of SMI were highest for persons aged 18 to 25 (13.2 percent) and lowest for persons aged 50 or older (4.9 percent). The percentage of females with SMI was higher than the percentage of males (10.5 vs. 6.0 percent).
Adults who used illicit drugs were more than twice as likely to have SMI as adults who did not use an illicit drug. In 2002, among adults who used an illicit drug in the past year, 17.1 percent had SMI in that year, while the rate was 6.9 percent among adults who did not use an illicit drug.
SMI was highly correlated with substance dependence or abuse. Among adults with SMI in 2002, 23.2 percent (4.0 million) were dependent on or abused alcohol or illicit drugs, while the rate among adults without SMI was only 8.2 percent.
Among adults with substance dependence or abuse, 20.4 percent had SMI. The rate of SMI was 7.0 percent among adults who were not dependent on or abusing a substance.

Treatment for Mental Health Problems

In 2002, an estimated 27.3 million adults (13.0 percent) received mental health treatment in the 12 months prior to the interview.
Among the 17.5 million adults with SMI in 2002, 8.4 million (47.9 percent) received treatment for a mental health problem in the 12 months prior to the interview.
Among adults with SMI, 30.5 percent perceived an unmet need for mental health treatment in the 12 months prior to their interview. The most often reported reasons for not getting needed treatment were "could not afford the cost" (44.3 percent) and "did not know where to go for services" (20.5 percent).
In 2002, an estimated 4.8 million youths aged 12 to 17 received treatment or counseling for emotional or behavior problems in the year prior to the interview. This represents 19.3 percent of this population.
The reason cited most often by youths for their latest treatment session was "felt depressed" (49.5 percent of youths receiving treatment), followed by "breaking rules or acting out" (26.7 percent), "thought about killing self or tried to kill self" (19.5 percent), and "felt very afraid or tense" (19.5 percent).
The rate of mental health treatment among youths who used illicit drugs in the past year (26.7 percent) was higher than the rate among youths who did not use illicit drugs (17.2 percent).

Illicit Drug Use

The National Survey on Drug Use and Health (NSDUH) obtains information on nine different categories of illicit drug use: marijuana, cocaine, heroin, hallucinogens, inhalants, and nonmedical use of prescription-type pain relievers, tranquilizers, stimulants, and sedatives. In these categories, hashish is included with marijuana, and crack is considered a form of cocaine. Several drugs are grouped under the hallucinogens category, including LSD, PCP, peyote, mescaline, mushrooms, and "Ecstasy" (MDMA). Inhalants include a variety of substances, such as amyl nitrite, cleaning fluids, gasoline, paint, and glue. The four categories of prescription-type drugs (pain relievers, tranquilizers, stimulants, and sedatives) cover numerous drugs available through prescriptions and sometimes illegally "on the street." Methamphetamine is included under stimulants. Over-the-counter drugs and legitimate uses of prescription drugs are not included. Respondents are asked to report only uses of drugs that were not prescribed for them or drugs they took only for the experience or feeling they caused. NSDUH reports combine the four prescription-type drug groups into a category referred to as "any psychotherapeutics."

Estimates of "any illicit drug use" reported from NSDUH reflect use of any of the nine substance categories listed above. Use of alcohol and tobacco products, while illegal for youths, are not included in these estimates. Findings from the 2002 NSDUH on illicit drug use are summarized below.

In 2002, an estimated 19.5 million Americans aged 12 or older were current illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 8.3 percent of the population aged 12 years old or older.
Marijuana is the most commonly used illicit drug. In 2002, it was used by 75 percent of current illicit drug users. Approximately 55 percent of current illicit drug users used only marijuana, 20 percent used marijuana and another illicit drug, and the remaining 25 percent used an illicit drug but not marijuana in the past month. About 45 percent of current illicit drug users in 2002 (8.8 million Americans) used illicit drugs other than marijuana and hashish, with or without using marijuana as well.
In 2002, an estimated 2.0 million persons (0.9 percent) were current cocaine users, 567,000 of whom used crack during the same time period (0.2 percent). Hallucinogens were used by 1.2 million persons (0.5 percent), including 676,000 users of Ecstasy (0.3 percent). There were an estimated 166,000 current heroin users (0.1 percent).
Of the 8.8 million current users of illicit drugs other than marijuana, 6.2 million were current users of psychotherapeutic drugs. This represents 2.6 percent of the population aged 12 or older. Of those who reported current use of any psychotherapeutics, 4.4 million used pain relievers, 1.8 million used tranquilizers, 1.2 million used stimulants, and 0.4 million used sedatives.

Age

Rates of drug use showed substantial variation by age. For example, 4.2 percent of youths aged 12 or 13 reported current illicit drug use in 2002. As in other years, illicit drug use in 2002 tended to increase with age among young persons. It peaked among 18 to 20 year olds (22.5 percent) and declined steadily after that point with increasing age.
The types of drugs used also varied by age group. Among youths aged 12 to 17, 11.6 percent were current illicit drug users: 8.2 percent used marijuana, 4.0 percent used prescription-type drugs, 1.2 percent used inhalants, 1.0 percent used hallucinogens, and 0.6 percent used cocaine. Rates of use were highest for the young adult age group (18 to 25 years) at 20.2 percent, with 17.3 percent using marijuana, 5.4 percent using prescription-type drugs nonmedically, 2.0 percent using cocaine, and 1.9 percent using hallucinogens. Among adults aged 26 or older, 5.8 percent reported current illicit drug use: 4.0 percent used marijuana and 2.0 percent used prescription-type drugs. Less than 1 percent used cocaine (0.7 percent), hallucinogens (0.2 percent), and inhalants (0.1 percent).
Among youths, the types of drugs used also differed by age. Among 12 or 13 year olds, 1.7 percent used prescription-type drugs nonmedically, 1.4 percent used marijuana, and 1.4 percent used inhalants. Among 14 or 15 year olds, marijuana was the dominant drug used (7.6 percent), followed by prescription-type drugs used nonmedically (4.0 percent) and inhalants (1.6 percent). Marijuana also was the most commonly used drug among 16 or 17 year olds (15.7 percent), followed by prescription-type drugs used nonmedically (6.2 percent), hallucinogens (1.9 percent), and cocaine (1.3 percent). Only 0.6 percent of youths aged 16 or 17 used inhalants.
Although most drug use rates in 2002 were higher among youths and young adults compared with older adults, the age distribution of users varied considerably by type of drug. Almost half (47 percent) of current illicit drug users were aged 12 to 25. However, in 2002, 71 percent of hallucinogen users, as well as 71 percent of inhalant users, were 12 to 25 year olds. Conversely, only 38 percent of cocaine users and 43 percent of nonmedical psychotherapeutics users were in that age grouping.

Gender

As in prior years, men were more likely in 2002 to report current illicit drug use than women (10.3 vs. 6.4 percent). However, rates of nonmedical psychotherapeutic use were similar for males (2.7 percent) and females (2.6 percent), which was consistent with previous findings for these drugs.

Education

As in other years, illicit drug use rates were correlated with educational status in 2002. Among adults aged 18 or older, the rate of current illicit drug use was lower among college graduates (5.8 percent) compared with those who did not graduate from high school (9.1 percent), high school graduates (8.0 percent), or those with some college (9.1 percent). This is despite the fact that adults who had completed 4 years of college were more likely to have tried illicit drugs in their lifetime when compared with adults who had not completed high school (50.5 vs. 37.1 percent).

College Students

In the college-aged population (i.e., those aged 18 to 22 years old), the rate of current illicit drug use was nearly the same among full-time undergraduate college students (20.7 percent) as for other persons aged 18 to 22 years, including part-time students, students in other grades, and nonstudents (22.4 percent).

Employment

Current employment status was highly correlated with rates of illicit drug use in 2002. An estimated 17.4 percent of unemployed adults aged 18 or older were current illicit drug users compared with 8.2 percent of those employed full time and 10.5 percent of those employed part time.
Although the rate of drug use was higher among unemployed persons compared with those from other employment groups, most drug users were employed. Of the 16.6 million illicit drug users aged 18 or older in 2002, 12.4 million (74.6 percent) were employed either full or part time.

Geographic Area

Among persons aged 12 or older, the rate of current illicit drug use in 2002 was 9.7 percent in the West, 8.2 percent in the Northeast, 8.1 percent in the Midwest, and 7.6 percent in the South.
The rate of illicit drug use in metropolitan areas was higher than the rate in nonmetropolitan areas. Rates were 8.6 percent in large metropolitan counties, 8.9 percent in small metropolitan counties, and 6.6 percent in nonmetropolitan counties as a group. Within nonmetropolitan areas, counties that were urbanized had a rate of 8.0 percent, while completely rural counties had a rate of 5.4 percent. This is not a statistically significant difference, but this finding is consistent with the pattern reported in previous surveys.

Alcohol Use

The National Survey on Drug Use and Health (NSDUH) includes a set of questions asking about the recency and frequency of the consumption of alcoholic beverages, such as beer, wine, whiskey, brandy, and mixed drinks. An extensive list of examples of the kinds of beverages covered is given to respondents prior to the question administration. A "drink" is defined as a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. Times when the respondent only had a sip or two from a drink are not considered as consumption. For this report, estimates for the prevalence of alcohol use are reported primarily at three levels defined for both males and females and for all ages as follows:

Current use - At least one drink in the past 30 days (includes binge and heavy use).

Binge use - Five or more drinks on the same occasion at least once in the past 30 days (includes heavy use).

Heavy use - Five or more drinks on the same occasion on at least 5 different days in the past 30 days.

A summary of the findings from the 2002 NSDUH alcohol questions is given below:

About half of Americans aged 12 or older reported being current drinkers of alcohol in the 2002 survey (51.0 percent). This translates to an estimated 120 million people.
More than one fifth (22.9 percent) of persons aged 12 or older participated in binge drinking at least once in the 30 days prior to the survey. This translates to about 54 million people.
Heavy drinking was reported by 6.7 percent of the population aged 12 or older, or 15.9 million people.

Age

The prevalence of current alcohol use increased with increasing age in 2002, from 2.0 percent at age 12 to 6.5 percent at age 13, 13.4 percent at age 14, 19.9 percent at age 15, 29.0 percent at age 16, and 36.2 percent at age 17. The rate reached a peak of 70.9 percent for persons 21 years old.
Rates of binge alcohol use were 0.8 percent at age 12, 2.8 percent at age 13, 7.0 percent at age 14, 11.6 percent at age 15, 17.9 percent at age 16, and 25.0 percent at age 17. The rate peaked at age 21 (50.2 percent). a peak of 70.9 percent for persons 21 years old.
The highest prevalence of both binge and heavy drinking in 2002 was for young adults aged 18 to 25, with the peak rate of both measures occurring at age 21. The rate of binge drinking was 40.9 percent for young adults and 50.2 percent at age 21. Heavy alcohol use was reported by 14.9 percent of persons aged 18 to 25 and by 20.1 percent of persons aged 21. Binge and heavy alcohol use rates decreased faster with increasing age than did rates of past month alcohol use. While 58.8 percent of the population aged 45 to 49 in 2002 were current drinkers, 22.5 percent of persons within this age range were binge drinkers and 7.7 percent drank heavily. Binge and heavy drinking were relatively rare among people aged 65 or older, with reported rates of 7.5 and 1.4 percent, respectively.

Underage Alcohol Use

About 10.7 million persons aged 12 to 20 reported drinking alcohol in the month prior to the survey interview in 2002 (28.8 percent of this age group). Of these, nearly 7.2 million (19.3 percent) were binge drinkers, and 2.3 million (6.2 percent) were heavy drinkers.
More males than females aged 12 to 20 reported binge drinking in 2002 (21.8 vs. 16.7 percent).
Among persons aged 12 to 20, past month alcohol use rates in 2002 ranged from 15.5 percent for Asians and 19.3 percent among blacks to 32.8 percent for whites. Binge drinking was reported by 22.7 percent of underage whites, 22.6 percent of underage American Indians or Alaska Natives, and 16.8 percent of underage Hispanics, but only by 8.6 percent of underage Asians and 9.8 percent of underage blacks.

Substance Abuse Trends

Marijuana

The percentage of youths aged 12 to 17 who had ever used marijuana declined slightly from 2001 to 2002 (21.9 to 20.6 percent). Among young adults aged 18 to 25, the rate increased slightly from 53.0 percent in 2001 to 53.8 percent in 2002.
In 1965 and 1966, only 1.8 percent of youths had ever used marijuana. Beginning in 1967, use increased until it reached a peak at 19.6 percent in 1979. A period of decline followed until 1991, when the rate was 11.5 percent, after which the trend reversed, reaching a peak at 21.9 percent in 2001.
The percentage of young adults aged 18 to 25 who had ever used marijuana was 5.1 percent in 1965, but increased steadily to 54.4 percent in 1982. Although the rate for young adults declined somewhat from 1982 to 1993, it did not drop below 43 percent and actually increased to 53.8 percent by 2002.

Cocaine

The percentage of youths aged 12 to 17 who had ever used cocaine increased slightly from 2001 to 2002 (2.3 to 2.7 percent). Among young adults aged 18 to 25, the rate increased slightly from 14.9 percent in 2001 to 15.4 percent in 2002.
From 1965 to 1967, only 0.1 percent of youths had ever used cocaine, but rates rose throughout the 1970s and 1980s, reaching 2.2 percent in 1987. A period of decline followed in the early 1990s, after which the trend reversed, reaching a peak at 2.7 percent in 2002.
The percentage of young adults aged 18 to 25 who had ever used cocaine was below 1 percent during the mid-1960s, but rose steadily throughout the 1970s and early 1980s, reaching 17.9 percent in 1984. By 1996, the rate had dropped to 10.1 percent, but climbed to 15.4 percent in 2002.

Heroin

Since the mid-1990s, the prevalence of lifetime heroin use increased for both youths and young adults. From 1995 to 2002, the rate among youths aged 12 to 17 increased from 0.1 to 0.4 percent; among young adults aged 18 to 25, the rate rose from 0.8 to 1.6 percent.

Hallucinogens

The prevalence of lifetime hallucinogen use among youths aged 12 to 17 was at its highest level in 2001 (6.1 percent) but declined to 5.7 percent in 2002. Among young adults aged 18 to 25, use increased from 14.3 percent in 1992 to 24.2 percent in 2002. The increase in hallucinogen use in the 1990s appears to have been driven by the use of Ecstasy (i.e., MDMA).

Psychotherapeutics

Psychotherapeutics include the nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; they also include methamphetamine. This drug category excludes over-the-counter substances.
Lifetime nonmedical pain reliever prevalence among youths aged 12 to 17 increased from 2001 (9.6 percent) to 2002 (11.2 percent), continuing an increasing trend from 1989 (1.2 percent). Among young adults aged 18 to 25, the rate increased from 19.4 percent in 2001 to 22.1 percent in 2002. The young adult rate had been 6.8 percent in 1992.
Lifetime nonmedical use of stimulants increased steadily from 1990 to 2002 for youths aged 12 to 17 (0.7 to 4.3 percent). For young adults aged 18 to 25, rates declined from 1981 to 1994 (from 10.9 to 5.9 percent), then increased to 10.8 percent in 2002. Rates increased between 2001 and 2002 for both youths (3.8 to 4.3 percent) and young adults (10.2 to 10.8 percent).

Cigarettes

The rate of lifetime cigarette use among youths aged 12 to 17 has remained between 29 and 39 percent in every year since 1965. Although the rate increased during the 1990s from 30.3 percent in 1990 to 37.8 percent in 1999, there was a significant decline from 2001 to 2002 (from 37.3 to 33.3 percent).
From 1965 to 1980, there was little change in the rate of lifetime cigarette use among boys aged 12 to 17. Rates were 37.9 percent in 1965 and 37.8 percent in 1980. However, during that period, the rate among adolescent girls increased from 21.7 to 36.2 percent. Since 1980, rates for girls have been nearly the same as the rates for boys.
The rate of lifetime daily cigarette use among youths aged 12 to 17 declined from 10.6 percent in 2001 to 8.2 percent in 2002. There also was a small decline in lifetime prevalence among young adults (37.7 to 37.1 percent) from 2001 to 2002.
Since 1965, the rate of lifetime cigarette use among young adults aged 18 to 25 has been between 65 and 72 percent.

Drug or Alcohol Substance Dependence or Abuse

Age at First Use

Adults who first used drugs at a younger age were more likely to be classified with dependence or abuse than adults who initiated use at a later age. For example, among adults aged 18 or older who first tried marijuana at age 14 or younger, 13.0 percent were classified with illicit drug dependence or abuse compared with only 2.8 percent of adults who had first used marijuana at age 18 or older. This pattern of higher rates of dependence or abuse among persons initiating their use of marijuana at younger ages was observed among demographic subgroups.
A similar pattern was observed for age at first use of alcohol and dependence on or abuse of alcohol among adults. Among adults aged 18 or older who first tried alcohol at age 14 or younger, 17.9 percent were classified with alcohol dependence or abuse compared with only 3.7 percent of adults who had first used alcohol at age 18 or older.

Age

Rates of substance dependence or abuse showed substantial variation by age. The rate for dependence or abuse was 1.0 percent at age 12, and rates generally increased for each successive year of age until the highest rate (26.8 percent) was reached at age 21. After age 21, the rates generally declined with age.
The rate of substance dependence or abuse was 8.9 percent for youths aged 12 to 17; it was 21.7 percent for persons aged 18 to 25 and 7.3 percent for persons aged 26 or older. Illicit drugs accounted for 62 percent of youths with substance dependence or abuse, 38 percent of persons aged 18 to 25, and 24 percent of persons aged 26 or older.

Gender

Among persons aged 12 or older, males (12.8 percent) were twice as likely as females (6.1 percent) to be classified with substance dependence or abuse.
Among youths aged 12 to 17, the rate of substance dependence or abuse among females (8.6 percent) was not significantly different from the rate among males (9.3 percent).

Treatment for a Substance Use Problem

Estimates described in this section refer to treatment received to reduce or stop drug or alcohol use, or for medical problems associated with the use of illicit drugs or alcohol. This includes treatment received in the past year at any location, such as in a hospital, at a rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, self-help group, or prison/jail. The definition of treatment in this section is different from the definition of treatment described in Section 8.3 (specialty treatment), which excludes treatment at an emergency room, private doctor's office, self-help group, prison or jail, or at a hospital as an outpatient.

An estimated 3.5 million people aged 12 or older (1.5 percent of the population) received some kind of treatment for a problem related to the use of alcohol or illicit drugs in the 12 months prior to being interviewed in 2002. Of these, 1.34 million received treatment for both alcohol and illicit drugs, 0.7 million received treatment for illicit drugs but not alcohol, and 1.1 million received treatment for alcohol but not illicit drugs. (Estimates by substance do not add to the total because the total includes persons who reported receiving treatment but did not report which substance the treatment was for.)

Age, Gender, and Race/Ethnicity

Among persons aged 12 or older in 2002, males were more likely than females to receive treatment for an alcohol or illicit drug problem in the past year (2.1 vs. 0.9 percent, respectively). Among youths aged 12 to 17, males also were more likely to receive treatment than females (1.7 vs. 1.2 percent, respectively).
Among persons aged 12 or older in 2002, the rates of alcohol or illicit drug treatment during the 12 months prior to the interview were highest among American Indians/Alaska Natives (4.8 percent), blacks (2.2 percent), and persons reporting two or more races (2.1 percent). The lowest rate of treatment was among Asians (0.2 percent).

County Type

The rates for any illicit drug treatment among persons aged 12 or older in 2002 were 1.0 percent in small metropolitan areas, 0.9 in large metropolitan counties, and 0.6 percent in all nonmetropolitan counties. The rate was 0.4 percent in completely rural counties.

Location and Substance

Among the 3.5 million persons aged 12 or older who received treatment for alcohol or illicit drugs in the past year, more than half (2.0 million) received treatment at a self-help group. There were 1.5 million people who received treatment at a rehabilitation facility as an outpatient, 1.1 million who received treatment at a rehabilitation facility as an inpatient, 1.0 million at a mental health center as an outpatient, 859,000 at a hospital as an inpatient, 523,000 at a private doctor's office, 469,000 at an emergency room, and 259,000 at a prison or jail. (Note that the estimates of treatment by location include persons reporting more than one location.)
More than half (2.2 million) of the 3.5 million persons who received treatment for a substance in the past year received treatment for alcohol during their most recent treatment. An estimated 974,000 persons received treatment for marijuana, 796,000 persons received treatment for cocaine, 360,000 for pain relievers, and 277,000 for heroin. (Note that the estimates of treatment by substance include persons reporting more than one substance.)

Needing and Receiving Specialty Treatment

This section discusses the need for and receipt of treatment for a substance use problem at a "specialty" treatment facility. It includes estimates of the number of persons needing and receiving treatment, as well as those needing but not receiving treatment. These estimates are specified separately for alcohol, for drugs, and for drugs or alcohol. Specialty treatment is treatment received at drug or alcohol rehabilitation facilities (inpatient or outpatient), hospitals (inpatient only), or mental health centers. It excludes treatment at an emergency room, private doctor's office, self-help group, prison or jail, or hospital as an outpatient. An individual is defined as needing treatment for an alcohol or drug problem if he or she was dependent on or abused alcohol or drugs or received specialty treatment for alcohol or drugs in the past 12 months.

An individual needing treatment for an illicit drug problem is defined as receiving treatment for his or her drug problem only if he or she reported receiving specialty treatment for drugs in the past year. Thus, an individual who needed treatment for illicit drugs but only received specialty treatment for alcohol in the past year was not counted as receiving treatment for drugs. Similarly, an individual who needed treatment for an alcohol problem who only received specialty treatment for drugs was not counted as receiving alcohol treatment. Individuals who reported receiving specialty substance abuse treatment but were missing information on whether the treatment was specifically for alcohol or drugs were not counted in estimates of specialty drug treatment or in estimates of specialty alcohol treatment; however, they were counted in estimates for "drug or alcohol" treatment.

In 2002, the estimated number of persons aged 12 or older needing treatment for an alcohol or illicit drug problem was 22.8 million (9.7 percent of the total population). Of these, 2.3 million persons (1.0 percent of the total population aged 12 or older; 10.3 percent of those who needed treatment) received treatment at a specialty substance abuse facility in the past 12 months and 20.5 million persons (8.7 percent of the total population) did not receive treatment at a specialty substance abuse facility.

Of the 2.3 million people aged 12 or older (1.0 percent of the population) who received some kind of specialty substance treatment, 709,000 persons received treatment for both alcohol and illicit drugs, 840,000 persons received treatment for alcohol only, and 703,000 persons received treatment for illicit drugs only. (Estimates by substance do not add to the total because the total includes persons who reported receiving specialty treatment but did not report which substance the treatment was for.)
More than half of the 2.3 million persons aged 12 or older who received specialty substance treatment in the past year also received treatment at a self-help group (1.5 million persons). An estimated 458,000 had received treatment at an emergency room, 401,000 at a doctor's office, and 198,000 at a prison or jail.
Of the 20.5 million people who needed but did not receive treatment in 2002, an estimated 1.2 million (5.8 percent) reported that they felt they needed treatment for their alcohol or drug problem. Of the 1.2 million persons who felt they needed treatment, 446,000 (37.5 percent) reported that they made an effort but were unable to get treatment and 744,000 (62.5 percent) reported making no effort to get treatment.
There were 2.3 million youths aged 12 to 17 (9.1 percent of this population) who needed reatment for an alcohol or illicit drug problem in 2002. Of this group, only 186,000 youths received treatment (8.2 percent of youths who needed treatment), leaving an estimated 2.1 million youths who needed but did not receive treatment for a substance abuse problem.

Illicit Drug Treatment and Treatment Need

In 2002, the estimated number of persons aged 12 or older needing treatment for an illicit drug problem was 7.7 million (3.3 percent of the total population). Of these persons, 1.4 million (18.2 percent) received treatment for drug abuse at a specialty substance abuse facility in the past 12 months.
The estimated number of persons needing treatment for an illicit drug problem who did not receive treatment was 6.3 million people in 2002, or 2.7 percent of the total population aged 12 or older.
Persons classified with dependence on or abuse of cocaine were more likely to receive specialty treatment for illicit drugs (24.3 percent) in the past year than persons classified with dependence on or abuse of any other illicit drug. The rate of specialty treatment for illicit drugs was 11.0 percent among persons with dependence on or abuse of illicit drugs. The rate was 18.2 percent for persons with dependence on or abuse of pain relievers, 13.3 percent for those with dependence on or abuse of hallucinogens, 7.6 percent for persons with dependence on or abuse of marijuana or hashish, and 4.1 percent for persons with dependence on or abuse of inhalants.
Of the 6.3 million people aged 12 or older who needed drug treatment but did not receive treatment at a specialty facility in 2002, an estimated 362,000 (5.7 percent) reported that they felt they needed treatment for their drug problem. This included an estimated 88,000 (24.4 percent) who reported that they made an effort but were unable to get treatment and 274,000 (75.6 percent) who reported making no effort to get treatment.
For youths aged 12 to 17, an estimated 1.4 million persons (5.7 percent) needed treatment for an illicit drug abuse problem in 2002. Of this group, only 0.1 million people received treatment (10.0 percent of youths aged 12 to 17 who needed treatment), leaving an estimated 1.3 million youths who needed but did not receive treatment.
Among the 1.4 million persons who received specialty treatment for an illicit drug problem in the past year, 33.9 percent reported "own savings or earnings" as a source of payment for their most recent specialty treatment. An estimated 30.0 percent reported private health insurance, 26.1 percent reported Medicaid, and 23.3 percent reported public assistance other than Medicaid as a source of payment. An estimated 20.3 percent reported Medicare, and 16.2 percent reported family members. (Note that the estimates of treatment by source of payment include persons reporting more than one source.)

Alcohol Treatment and Treatment Need

In 2002, the estimated number of persons aged 12 or older needing treatment for an alcohol problem was 18.6 million (7.9 percent of the total population). Of these, 8.3 percent (1.5 million) received alcohol treatment at a specialty substance abuse facility in the past 12 months.
The estimated number of persons needing treatment for alcohol but who did not receive treatment was 17.1 million people in 2002, or 7.3 percent of the total population aged 12 or older.
Of the 17.1 million people who needed but did not receive alcohol treatment for their alcohol problem in 2002, an estimated 761,000 (4.5 percent) reported that they felt they needed treatment for their alcohol problem. Of the 761,000 persons, 266,000 (35 percent) reported that they made an effort but were unable to get treatment and 495,000 (65 percent) reported making no effort to get treatment.
There were 1.5 million youths aged 12 to 17 (6.0 percent) who needed treatment for an alcohol problem in 2002. Of this group, only 0.1 million received treatment (8.1 percent of youths aged 12 to 17 who needed treatment), leaving an estimated 1.4 million youths who needed but did not receive treatment.
Among the 1.5 million persons who received specialty treatment for an alcohol problem in the past year, 46.3 percent reported "own savings or earnings" as a source of payment for their most recent specialty treatment. An estimated 31.7 percent reported using private health insurance, 21.5 percent reported public assistance other than Medicaid, and 21.4 percent reported Medicaid. An estimated 19.0 percent reported using Medicare, and 15.2 percent reported family members. (Note that the estimates of treatment by source of payment include persons reporting more than one source of payment.)

Results from the 2002 National Survey on Drug Use and Health (NSDUH)